=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356797377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JL RIVERA & SONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2016
-----------------------------------------------------
Last Update Date | 03/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PR 3 AVE LOS VETERANOS VILLA ROSA III
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-617-0761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1853
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00785-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-617-0761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LAURA C RIVERA IRIZARRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-617-0761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 1357
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------